摘要
目的观察普外科手术患者术后不同镇痛方式对血清相关细胞因子的影响,并提出优选的术后镇痛方法。方法采用随机数字表法将30例腹部手术患者均分为两组:A组患者术后采用静脉自控镇痛;B组采用镇痛泵进行硬膜外自控镇痛。血清前炎性细胞因子IL-6、IL-8和TNF-α水平测定均采用放射免疫分析法。手术麻醉均采用全麻气管插管加硬膜外麻醉方式。结果两组术后镇痛方式患者的血清前炎性细胞因子IL-6、IL-8和TNF-α水平自术后6 h始[A组:(85.03±8.77)pg·mL^(-1),(12.01±7.23)ng·mL^(-1),(17.45±7.51)ng·mL^(-1);B组:(62.10±6.97)pg·mL^(-1),(8.57±3.01)ng·mL^(-1),(9.59±4.78)ng·mL^(-1)]升高(t值分别为-6.425,-4.886,-7.102,均P<0.05),峰值均位于24 h[A组:(78.31±7.98)pg·mL^(-1),(15.17±7.87)ng·mL^(-1),(20.21±12.23)ng·mL^(-1);B组:(65.35±4.03)pg·mL^(-1),(9.41±4.18)ng·mL^(-1),(12.34±7.92)ng·mL^(-1)],而A组患者均高于B组患者(t值分别为6.481,4.197,6.218,均P<0.05),48 h水平恢复速率B组优于A组(t值分别为9.290,2.612,2.791,均P<0.05)。IFN-γ自术后6 h始下降[A组:(9.01±2.04)μg·mL^(-1),B组:(12.01±5.04)μg·mL^(-1),t=-4.098,P<0.05],谷值同位于前炎性细胞因子的时间段(24 h),而A组患者均低于B组患者[A组:(7.52±2.68)μg·mL^(-1),B组:(11.47±4.87)μg·mL^(-1),t=-2.092,P<0.05],48h水平恢复速率B组也优于A组(t=-6.284,P<0.05)。自各时点VAS评分结果看,两组术后VAS评分高峰位于6 h处,24 h后下降,6 h和24 h两组VAS评分B组低于A组[A组:(3.72±1.43)分,(3.52±1.29)分,B组:(2.61±0.98)分,(2.21±0.98)分,t=4.293,5.972,均P<0.05]。48 h两组之间差异无统计学意义[A组:(1.17±0.98)分,B组:(1.08±0.95)分,t=-0.838,P>0.05]。两组VAS评分均低于术毕组(均P<0.05)。结论两组术后镇痛方式患者都发生不同程度的应激反应,但总体衡量硬膜外自控镇痛优于静脉自控镇痛。
Objective To discuss the clinical value of changes of serum related inflammatory cytokine levels in postoperative patients with different analgesia method,and to propose the optimal postoperative analgesia. Methods Thirty patients after surgical operation according to the different methods of analgesia were assigned into 2 groups by the randomized digital method： Group A was treated by the method of intravenous analgesia,while group B was treated by the method of epidural analgesia. The levels of serum IL-6,IL-8,IFN-γ and TNF-α were determined by radioimmunoassay. Surgical anesthesia was performed by tracheal intubation combined with epidural anesthesia. Results The levels of serum IL-6,IL-8,and TNF-α from 6 h after operation were all significantly increased { [group A：（ 85. 03 ± 8. 77） pg·mL^（-1）,（ 12. 01 ± 7. 23） ng·mL^（-1）,（ 17. 45 ± 7. 51） ng·mL^（-1） vs. [group B：（ 62. 10 ± 6. 97） pg·mL^（-1）,（ 8. 57 ± 3. 01） ng·mL^（-1）,（ 9. 59 ± 4. 78） ng·mL^（-1）]}（ t =-6. 425,-4. 886,-7. 102,all P〈0. 05）. Two groups of peaks are located at 24 time periods,the levels of serum IL-6,IL-8,IFN-γ and TNF-α in group A were significantly higher than those in the group B{ [group A：（ 78. 31 ± 7. 98） pg·mL^（-1）,（ 15. 17 ± 7. 87） ng·mL^（-1）,（ 20. 21 ± 12. 23） ng·mL^（-1）]vs.[group B：（ 65. 35 ± 4. 03）pg·mL^（-1）,（ 9. 41 ± 4. 18） ng·mL^（-1）,（ 12. 34 ± 7. 92） ng·mL^（-1）]}（ t = 6. 481,4. 197,6. 218,all P〈0. 05）. The recovery rate of serum inflammatory cytokine levels of at 48 h in group B was better than that in group A（ t = 9. 290,2. 612,2. 791,all P〈0. 05）. At the same time,the levels of serum IFN-γ from 6 h after operation were significantly decreased group A：（ 9. 01 ± 2. 04） μg·mL^（-1） vs.group B：（ 12. 01 ± 5. 04） μg·mL^（-1）（ t =-4. 098,P〈0. 05）. This indexed low peak levels in the 24 h time period. Moreover,levels of serum IFN-γ in group A [（ 7. 52 ±
作者
禚海成
荆炳霞
朱静
ZHOU Haicheng;JING Bingxia;ZHU Jing(a.Anesthesia Department,1b.Nuclear Medicine,Changshu No.2 People＇s Hospital,Changshu,Jiangsu 215500,China;Changshu Medical Testing Center,Changshu,Jiangsu 215500,China)
出处
《安徽医药》
CAS
2018年第10期1894-1897,共4页
Anhui Medical and Pharmaceutical Journal
关键词
镇痛
病人控制
白细胞介素6
白细胞介素8
干扰素Γ
肿瘤坏死因子α
消化系统外科手术
Analgesia
patient-controlled
Interleukin-6
Interleukin-8
Interferon-gamnla
Tumor necrosis faCTor-alpha
Digestive systemsurgical procedures
